ISSN 2521-2230
PAKISTAN NATIONAL JOINT REGISTRY 2018 - 2019
Fifth Annual Report
PNJR Report 2018-19
Theme PNJR 5th year of trailblaizing: Setting the bar for healthcare registries in Pakistan 5th Annual report of Pakimstan National Joint Registry
Dedicated to the work of scientists and scholars of Pakistan
Pakistan Arthroplasty Society (PAS) Pakistan National Joint Registry (PNJR) www.arthroplasty.org.pk www.pasnjr.org
01 Partners of Pakistan Arthroplasty Society (PAS)
Spanish Knee Society Contents
Foreword 05 APOA President Message 07 PNJR Director Message 09 List of Authors 11 PNJR Steering Committee 13
Part 1: PNJR from infancy to a leader in National Health Registries I. Journey of PAS and PNJR 15 II. Upgrades in the Data Collection Model 19 III. PNJR Clinical Coordinator Network 29 IV. PNJR Partnership with HRAB (Health Research Advisory Board) 33 V. PNJR Stake Holders Network 37 VI. Consolidating Performance and Compliance 45
Part 2: Data Analysis and Reporting
I. Primary Total Knee Arthroplasty 49 II. Revision Total Knee Arthroplasty 63 III. Primary Total Hip Arthroplasty 69 IV. Revision Total Hip Arthroplasty 83
PAS Current National Board 88 International Fellows 89 National Fellows 90
Foreword
At a time when numerous countries in the West are struggling with implementing or upkeeping joint registries, Pakistan once again shows itself to be ahead of the curve. The joint registry report that has been put together is comprehensive, informative and relevant. Thanks to the vision of luminaries such as Prof Noor, Prof Chinoy and the other scholars who are listed on the authors list, you have put Pakistan on the map again by producing this great compendium.
I like the mention of non-orthopedic Pakistani Noble laureates, scientists, and visionaries in the report who serve humanity in various capacities in di erent parts of the world.
It is wonderful, but not surprising, to see the association between Pakistan Orthopedic Association and numerous other international organizations. The leadership of Pakistan Orthopedic Association has been present and contributed to the educational mission of many relevant international meetings. They have forged friendship with other educators and organizations that will serve our patients for the years to come. I am personally a bene ciary of these friendships. I have enjoyed learning from my friends in Pakistan about orthopedics, life and more importantly about humanity.
I strive to visit your beautiful country, the basin of human civilization and my generous friends. I take pride in wearing the POA tie that I was given a few years ago and declaring my association with POA to my patients.
I am honored to call many of you friends and hope to have the chance to forge friendship with other scholars whom I am yet to meet.
May Allah bless you, your families, your nation and your beautiful country.
Sincerely yours
Javad Parvizi MD, FRCS James Edwards Professor of Orthopedic Surgery, Sidney Kimmel Medical College Rothman Institute at Thomas Je erson University Hospital Sheridan Building, Suite 1000 125 South 9th Street Philadelphia, PA 19107
Foreword 05
Message
President APOA
First of all, I would like to thank the President Prof. Dr. Shahid Noor for his kind invitation to write this message for the 5th Annual Report of the Pakistan National Joint Registry (PNJR). It’s an honor and pleasure for me to write the message for the 5th annual report of PNJR.
Since it’s initiation in Sweden in 1975, national joint arthroplasty registries have been used increasingly by many other countries, worldwide. They are extremely useful, and valueable scienti cally in monitoring the clinical results, and outcomes of joint arthroplasties in national aspects, comparatively.
Moreover, the International Society of Arthroplasty Registries (ISAR) acts as the international coverage of national joint arthroplasty registries.
I congratulate the President Prof. Dr. Shahid Noor for his relevant contributions, and e orts. I strongly believe that the contribution of the Pakistan Arthroplasty Society with the project PNJR in its 6th successful year is important, and valuable in both Asia Paci c region, and the whole world.
I recommend this report for all our colleagues who are interested in the eld of arthroplasty.
Finally, I would like to invite you to the 21st APOA Biennial Congress in Malaysia in 2020.
Sincerely yours
Prof. Mahmut Nedim DORAL, M.D. President, APOA Chair Of Department of Orthopedics & Trauma Hacettepe University
APOA President Message 07
Message
Director PNJR
It is a matter of immense pleasure and pride for me to present to you this 5th Annual Report of Pakistan National Joint Registry (PNJR). It is the continuous zeal, e ort and commitment of the executive board of Pakistan Arthroplasty Society (PAS), the authors of this report and more importantly the contributors who have registered their cases into the database that has made us proud by lifting the standard of our registry for the 5th consecutive year, to produce a world class report.
We have strived hard to control the problems encountered every year in production of this report and one of the major work has been on cleaning of data for which I would like to praise the work put in by our o cial research partners-Metrics Research. We have choosen a unique theme of introducing Pakistani scientists. This shows the immense talent that our beautiful country cultivates and that presents the hard work of many scientists in austere circumstances. Our registry is akin to such work of scienti c relevance that puts us right on top with other countries of the developed world who have national joint registries. Though far from being perfect, we are well on track in the quest to join the elite of the world of arthroplasty.
You can also see that with each passing year we are gaining popularity and this is re ected in the continuous growth of centers, PI’s and the number of joints registered. I am hopeful that this e ort of the Pakistan Arthroplasty Society will go a long way in shaping the future of joint replacement surgery in Pakistan and a ect many scienti c databases in collaborative research across the region and the globe.
The board of PNJR has been successfull in guiding and developing many surgical and medical national registries in Pakistan including cardiology registry of Pakistan, diabetic registry of Pakistan, stroke registry of Pakistan and hepatitis registries of Pakistan. We are encouraging our colleagues and subspeciality orthopedic societies to develop national registries.
Sincerely yours
Prof. Syed Shahid Noor MD, FRCS(Tr&Orth) Director, Pakistan National Joint Registry. President, Pakistan Arthroplasty Society. President, Pakistan Orthopaedic Association (2017-2018) Founder Principal and project director, Liaquat National Medical College. Chairman Registry Committee, Health Research Advisory Board. Head, Department of Orthopaedic, Liaquat National Hospital and Medical College.
PNJR Director Message 09 Dr. Naweed Syed
He is a Pakistani Canadian scientist. He is the rst scientist who managed to 'connect brain cells to a silicon chip'. Dr. Naveed estimates science- ction type 'Machine-Men' may be developed within 10 to 20 years, using his silicon chip. Currently he is a Professor and Head Department of Cell Biology & Anatomy at the University of Calgary, Canada. He was featured in Time Magazine (Canada) as well. List of Authors
1 Prof. Syed Shahid Noor MBBS, FRCS(Eng), FRCS(Edin), FRCS(Tr&Orth) President, Pakistan Orthopaedic Assocaiation (POA) President, Pakistan Arthroplasty Society (PAS) Director, Pakistan national joint registry Head of Dept, Ortopedics, Liaquat National Hospital and Medical College, Karachi 2 Prof. Muhammad Amin Chinoy MBBS, FRCS Past President, Pakistan Orthopaedic association (POA) Treasurer, Pakistan Arthroplasty Society (PAS) National Coordinator,PNJR Head of dept, Orthopaedics The indus hospital Karachi. 3 Dr. Muhammad Ather Siddiqi MBBS, FCPS (Orth), FRCS(Glas) Joint Secretary south, PAS Assistant Professor, Dept of orthopaedics Liaquat National Hosptial and Medical College Karachi 4 Dr. M. Kazim Rahim Najjad MBBS, MD, FCPS (Orth) Executive Board Member, PAS Assistant Professor, Dept of orthopaedics Liaquat National Hospital and Medical College Karachi 5 Dr. Muhammad Sufyan MBBS, FCPS (Orth) Assistant Professor, Dept of orthopaedics Liaquat National Hospital and Medical College Karachi 6 Dr. Mehroze Zamir MBBS, FCPS (Trauma & orthopaedics) PAS Fellow Liaquat National Hospital and Medical College Karachi 7 Dr. Faizan Iqbal MBBS, FCPS (Trauma & orthopaedics) Senior Registrar Liaquat National Hospital and Medical College Karachi
List of Authors 11 Ayub Khan Ommaya
Dr. Ommaya published over 150 articles, chapters, and books. His research focused on cancer treatment, traumatic brain injury, a CSF arti cial organ, and philosophy of mind. He developed Ommaya reservoir in 1963. The reservoir was the rst medical port to use silicone which is biologically inert and self-sealing. Steering Committee
Professor Syed Shahid Noor Professor Muhammad Amin Chinoy Director PNJR National Coordinator PNJR Email: [email protected] Email: [email protected]
Professor Khalil Gill Professor Major General Suhail Hafeez General Secretary POA Regional Coordinator PNJR (Punjab) Email: [email protected] Email: [email protected]
Professor Muhammed Arif Khan Professor Mansoor Ali Khan Regional Coordinator PNJR (KPK) Regional Coordinator PNJR (Sindh) Email: [email protected] Email: [email protected]
Dr. Saleh Mohammad Tareen Research Partner Regional Coordinator PNJR (Baluchistan) 1. Health Reserch Advisory Board (HRAB) Email: [email protected] 2. Metrics Research
Steering Committee 13 INTRODUCING PART 1 PNJR 5th Annual Report Journey of PAS and PNJR SECTION I Sayed Amjad Hussain
Sayed Amjad Hussain is another Pakistani inventor who invented two surgical devices – the pleuroperitoneal shunt and a special endotracheal tube. Dr. Hussain is a member of 17 professional organizations, 10 administrative positions, is a visiting professor to 12 universities throughout the world and is a member of the editorial board of 6 medical journals. SECTION I
Broadening Partnerships with Health Registeries
PNJR has been setting the bar in many areas of registry development in the eld of healthcare in Pakistan. Our partnership with health registry advisory board (HRAB) has led us to become leaders in the eld in the country, Through this platform, we have partnered with multiple healthcare registries in the last 5 years.
We have introduce the concept of disease speci c registries, emphasized the use of ICH-GCP guidelines in establishing and conducting health registries across the board as well as the culture of regularly updating and modifying data entry according to end user feedback mechanisms.
The next logical step for us now is to start formulating a governing body for all health care associated registries to ensure compliance to the highest standards by all steering committees and their registered investigator. This is as anticipated a daunting task since all registries currently operating under HRAB umbrella are voluntary and improving compliance is di cult. Yet our partnerships with other elds of medicine have enabled us to set and example and most other registry steering committees are in direct contact with us to broaden the partnership, Share technical knowledge in order to improve their data collection. The learn from our mistakes and successes and want to collaborate in every aspect. We are positive that these partnerships can lead to uni ed drive to setting up a voluntary governing body for healthcare registries in Pakistan.
At some point in time when our successful model is robust enough to be self-sustainable, we envision that these registries become associated with local health authorities and become compulsory rather than voluntary. For this we will have to demonstrate a successful running model to the government which we shall achieve in the near future and hopefully in the upcoming issues if the PNJR annual report, we shall tell our readers how the PNJR has literally been the matchstick to light up the re of national healthcare database collection.
I Broadening Partnerships with Health Registeries 17 Abdul Qadeer Khan
He made major contributions in molecular morphology, physical martensite, and its integrated applications in condensed and material physics. Upgrades in Data Collection Model to address Data Completeness SECTION II Professor Sohail Khan
Professor Sohail Khan, a Pakistani researcher at Loughborough University designed a clever lavatory that transforms human waste into biological charcoal and minerals. These can then be used as fuel or a form of conditioner for soil. It also produces clean water. His invention was appreciated by Bill Gates. SECTION II
Upgrades in Data Collection Model to address Data Completeness
The registry has constantly been subject to improvement with the passage of time. The most recent addition to the online CRF is introduction of option for entery of bilateral simultaneous joint arthroplasty. The users do not have to enter everything and the system retrieves the patients information for the second side automatically. The surgeon can then modify data entries to select the type of implant used and any other variables that needs to be changed.
Data entries are constantly monitored for completeness and cleanliness of data and a three monthly review is carried out. Users are informed about missing entries or erroneous data entries and the data is periodically modi ed. Data entry is being facilitated by the hiring of even more data collection o cers. We have fully functional data collection teams who regularly collect paper based CRF’s from hospitals across the country. Our main centers are
1. Karachi 2. Lahore 3. Islamabad/Rawalpindi 4. Peshawar
PI training for entering data is an ongoing process. Most of our original users are now very comfortable with the data entry interface. New users are constantly being trained to use the interface properly.
Appendices:
1. Total Knee Arthroplasty CRF 2. Total Knee Arthroplasty Follow up Form 3. Total Hip Arthroplasty CRF 4. Total Hip Arthroplasty Follow up Form
II Upgrades in the Data Collection Model 21 (Kg) (Feet) Aseptic Loosening Tibia Femur Osteolysis Tibia Femur
Anteroposterior Varus / Valgus Multi Planar
(degree) (degree)
(degree)
(degree)
(degree) (degree)
General + Epidural
Spinal + Epidural
All POLY
(days) (days) (days) Number (days) (days) (days) Date: / / KNEE FOLLOW-UP FORM
PATIENT DETAILS PNJR No
Surname Given Name CNIC #
Tel / Cell # Hospital Surgeon
Date of Surgery TKR (L/R) Hospital Reg. #
FOLLOW-UP VISIT
2 Weeks 6 Weeks 3 Months 6 Months
1 Year 5 Years 10 Years 15 Years
20 Years Others
FUNCTIONAL SCORE ( 0-100)
KNEE SOCIETY SCORE ( 0-100)
COMPLICATIONS
Hematoma DVT PE
Nerve Palsy Fracture Others
Wound Dehiscence Infection
Surgeon Comments
Completed by: Signature: 1. 9.
(Kg) (Feet) Oteolysis
Aseptic Loosening
2.
10. 3. (degree) (degree) General (degree) 11. General + Epidural
POSITION Spinal + Epidural 4. Supine Lateral (degree) (degree) Extended Trochanteric Osteotomy (degree) (degree) Extensile Approach (degree) (degree) 5.
12. 6.
13.
7.
8.
Hip
(days) (days) (days) (days) (days) (days)
Dual Mobility
Dual Mobility
Dual Mobility
Dual Mobility Death...... Date: / / HIP FOLLOW-UP FORM
PATIENT DETAILS PNJR No
Surname Given Name CNIC #
Tel / Cell # Hospital Surgeon
Date of Surgery THR (L/R) Hospital Reg. #
FOLLOW-UP VISIT
2 Weeks 6 Weeks 3 Months 6 Months
1 Year 5 Years 10 Years 15 Years
20 Years Others
HARRIS HIP SCORE ( 0-100)
COMPLICATIONS
Hematoma Wound Dehiscence Infection
Dislocation DVT PE
Nerve Palsy Fracture Others
Surgeon Comments
Completed by: Signature: SECTION II
Upgrades in the Data Collection
Growth in Number of Hospitals 107 103 97
55
2nd Year 3rd Year 4th Year 5th Year
Growth in Number of PI’s 148 145 139
85
2nd Year 3rd Year 4th Year 5th Year
26 Upgrades in the Data Collection Model II SECTION II
Upgrades in the Data Collection
Growth in Total Number of Joints Registered 2698
2185
1532
827 1175 714
637
416
158 120 94 76 77 62 43 59
2nd Year 3rd Year 4th Year 5th Year 2nd Year 3rd Year 4th Year 5th Year 2nd Year 3rd Year 4th Year 5th Year 2nd Year 3rd Year 4th Year 5th Year Primary TKA Revision TKA Primary THA Revision THA
II Upgrades in the Data Collection Model 27 Abdus Salam
Abdus Salam was a Pakistani theoretical physicist who won a Nobel Prize in Physics for his contribution to 'electroweak uni cation' in 1979. He is the rst Pakistani to receive a Nobel Prize. PNJR Clinical Coordinator Network SECTION III Mahbub ul Haq
Mahbub ul Haq was a Pakistani game theorist, economist and an international development theorist who served as the 13th Finance Minister of Pakistan from 10 April 1985 until 28 January 1988.
In 1988 in U.S., he served as the Special Adviser to the UNDP Administrator William Henry Draper. Here, Haq led the establishment of Human Development Report which includes the now popular “Human Development Index”, which measures development by people's well-being, rather than by their income alone. He returned to Pakistan in 1996 to establish the Human Development Center in Islamabad. SECTION III
st PNJR Clinical Coordinator Network 1 MULTINATIONL CRO OF PAKISTAN
“Metrics Research Pvt. Ltd. is a reputed Clinical Research Team Members Organization established since 2003, providing Clinical Research Services to well recognized medical societies, Mr. Syed Munawar Ali (CCRP) hospitals, pharmaceutical and clinical research Director Coordinator PNJR companies all across the globe. Metrics Research specializes in Clinical Registries, Surveillance studies, Statistical analysis through SPSS and SAS with professional writings, Phase Trials from Phase I to Phase IV and as well as Bio-Equivalence Studies. Ms. Yasmeen Fazal Metrics have highly quali ed, trained and experienced CRC Team Lead clinical research professionals for the execution of services that they o er to their respective clients. Metrics Research took PNJR registry as a challenge and with the experience and quali ed professional including CRA’s, Coordinator and Medical writers made this dream true. Metrics Research is responsible for Dr. Talha Javed training of new PI or Co-PI, Data entry facilitators and CRC Lahore Also responsible for the monitoring of data. Metrics Research experienced and quali ed medical writers are involved in data analysis and annual report writing as per international guide lines.”
Supporting Team Muhammad Asim Lead Developer and Mr. Faisal Farooq PNJR Application Manager Supporting Team
Mr. Syed Khalid Mansoor Mr. Ali Hyder Qureshi Supporting Team Supporting Team
Dr. Arif Muneer Mr. Naeem Khan Supporting Team Supporting Team
III PNJR Clinical Coordinator Network 31 Abdullah Sadiq
Abdullah Sadiq, PhD, Sitara-e-Imtiaz (born 1940), is a Pakistani physicist and ICTP laureate who received the ICTP Prize in the honour of Nikolay Bogolyubov, in the elds of Mathematics and Solid State Physics in 1987 for his contributions to scienti c knowledge in the eld of Mathematics and Statistical physics. He is the professor of physics and current Dean of the Department of Physics of the Air University of the Pakistan Air Force (PAF).
Sadiq is also a renowned educationist of Pakistan with a specialisation in nuclear physics, solid-state physics, and computer programming. He has been a distinguished professor of nuclear physics and solid state physics in many universities of Pakistan. PNJR Partnership with HRAB SECTION IV Sultan Bashiruddin Mahmood
Sultan Bashiruddin Mahmood is a Pakistani nuclear engineer. He has been an important part of Pakistan Atomic Energy Commission and regarded for development of the SMB probe to detect heavy water leaks in nuclear power plants. SECTION IV
PNJR Partnership with HRAB
Health Research Advisory Board (HealthRAB) a registered society, is a “think tank” of senior clinicians, researchers & academicians who are committed to the mission of HealthRAB which is to “Develop the Research Ecosystem of Pakistan”.
The main objectives of HealthRAB are to: • Provide leadership for developing the medical research ecosystem of Pakistan • Create synergy among the existing stakeholders and bring them together • Build capacity of the healthcare professionals involved in conducting research • Collaborate & network locally as well as globally to initiate research activities • Facilitate the development and implementation of a national research policy
Leadership: • Prof. Dr. Abdul Ga ar Billoo Chairman • Prof. Dr. Abdul Basit Vice Chairman • Dr. Zakiuddin Ahmed General Secretary • Prof. Syed Shahid Noor Chairman Registry Committee
DISEASE REGISTRIES
Pakistan National Joint Registry led by Projects & Activities: PNJR Prof. Dr. Shahid Noor 1 Online Research Course (ORC). Cardiac Registry of Pakistan led by 2 Research Reference Guide (RRG). CRoP Dr. Bashir Hanif 3 Research Assembly (RA). National Research Policy Document. Diabetes Registry of Pakistan led by 4 DRoP Prof. Dr. Abdul Basit 5 Disease Registries. 6 MLS, RM and SPSS Workshops. Stroke Registry of Pakistan led by SRoP Prof. Dr. Wasay Shakir. 7 Research Webinars. Clinical Research Center Workshop Hepatitis Registry of Pakistan led by 8 HRoP Prof. Dr. Zaigham Abbass and (CRC). Prof. Dr. Saeed Hamid 9 Student Chapters. Gynaecology Registry of Pakistan led by 10 Research Fund (RF). GRoP Prof. Dr. Fareed Zafar
IV PNJR Partnership with HRAB 35 SECTION II
PNJR Partnership with HRAB
1st Research Excellence Award at CardioCon 2016 at Poster Competition at 11th SAFOG Conference at Clinical Research Center Workshop (CRCs) at Hotel Serena, Faisalabad on 25th -27th Nov, 16. Lahore on 17th – 19th March, 2017. Mohtarma Benazir Bhutto Medical College.
Joint Technical Working Group for Medical Research Activities Webinar by Prof. Dr. Syed Shahid Noor held on 4th March, 17.
Prof. Dr. Abdul Gha ar Billoo presenting shield to HealthRAB’s Board Meeting Prof. Dr. Lawrence
1st International Medical Research Conference - IMRC
36 PNJR Partnership with HRAB IV PNJR Stake Holders Network SECTION V Naveed Zaidi
Organic Chemist and Polymer Scientist Naveed Zaidi developed world's first plastic magnet that functions at room temperature. Along with his colleagues Prof. Andy Monkman, Mr. Sean Giblin and Dr. Ian Terry from Department of Physics of Durham University, research took 4 years making him rst scientist to develop world's rst practical plastic magnet. SECTION V
PNJR Stake Holders Network
Pakistan National Joint Registry could not have been from data management, data tracking, data backup and formed without the commitments of its valuable stake cleaning to complete audit trails, reports/graph generation, holders. Each stake holder support and cooperation has dataset building for SAS/SPSS analysis. They also help in enabled us to achieve our 1st year targets. There are resolving technical site issues and provide training and number of stake holders but the following few are most support to maintain “Data Quality”. signi cant: IV Affiliated Institutions / Clinical Sites Institutes are the back bone of any clinical research activity. I Pakistan Arthroplasty Society All our registered hospitals are supporting us in providing: The board and members of Pakistan Arthroplasty access to patient data, logistics for data entry, utilities and Society take full ownership of PNJR project and have use of their valuable and reputable name. extended their extensive human and nancial resources for the realization of this project. All nancial funding for PNJR is exclusively supported by PAS. Sindh Karachi 1. Liaquat National Hospital & Medical College II Patients 2. The Aga Khan University and Hospital Patients are at the center of all we do. Without the 3. The Indus Hospital contribution of our patients, we would not have 4. Institute of Orthopaedic & Surgery achieved this 1st annual report. We believe that their 5. Ziauddin University and Hospital Clifton contribution will take us to newer heights in scienti c 6. Jinnah Postgraduate Medical Centre research to bene t the masses in general. PNJR steering 7. Civil Hospital, Dow University of Health Sciences committee extends their thanks to all those patients 8. Abbasi Shaheed Hospital 9. Dow International Medical College, DUHS who have contributed to this rst annual report. 10. Medicare Cardiac & General Hospital 11. South City Hospital 12. AO Clinic III Research/Registry development 13. Ashfaq Memorial Hospital partners 14. Combined Military Hospital 15. Darul Sehat Hospital Metrics Research Pvt. Ltd 16. National Medical Center Metrics Research took this project as a challenge and 17. Orthopaedic & Medical Institute OMI 18. Fatimiyah Hospital devotedly provided its services in designing of protocol, 19. Hamdard Hospital CRF, ICF, data entry and data analysis. The experienced 20. TO Clinic trained team members assisted PNJR in every step of 21. Hill Park General Hospital development and publication 22. Jinnah Medical & Dental Hospital 23. KPT Hospital 24. Ankle Saria Hospital Collage Solutions 25. Mamji Hospital Collage Solutions with an extensive knowledge and 26. Burhani Hospital experience in data management, EDC, eCRF, CTMS 27. Memon Medical Institute Hospital design and development provided the expertise to 28. Neurospinal & Cancer Care Institute develop PNJR registry database. These provide services 29. Park Lane Hospital
V PNJR Stake Holders Network 39 SECTION V
PNJR Stake Holders Network
30. Patel Hospital 58. Sheikh Zayed Hospital 31. PNS Shifa – Bahria University Medical & Dental College 59. Shoukat Khanum Hospital 32. Saifee Hospital 60. Services Institute of Medical Sciences (SIMS) 33. Karachi Adventist Hospital (7th Day Hospital) 61. Horizon Hospital 34. Zubaida Medical Centre 62. Sir Ganga Ram Hospital 35. The SNBB Truma Centre 63. Masood Hospital 36. Imam Clinic 64. Govt. Nawaz Sharif Hospital 37. Lyari General Hospital 65. Family Hospital 38. Aiwan-e-Tijarat-o-Sanat Hospital Trust 66. Mid City Hospital Jail Road 39. Dr. Ziauddin Hospital (North) 67. National Hospital Defence Lahore 40. Chiniot Hospital Korangi 68. Services Hospital 69. Wapda Teaching Hospital Hyderabad 70. Wah Medical College & POF Hospital 41. Bone and Joints Hospital 42. LUMHS Hospital Jamshoro Islamabad / Rawalpindi 71. Shifa International Hospital Larkana 72. Quaid-e-Azam International Hospital 73. Combined Military Hospital 43. Chandka Medical College & 74. Shaheed Zulfiqar Ali Bhutto Medical University Shaheed Benazir Bhutto Medical Institute 75. Kulsum International Hospital 76. Ali Medical Centre Nawabshah 77. Maroof International 44. Nawabshah Medical College & Hospital 78. NESCOM Hospital 45. Sha que Medical Center 79. KRL Hospital 46. Mastoi Medicare 80. Benazir Bhutto Hospital 81. Capital Hospital 82. DHQ Hospital Sukkur 83. Fauji Foundation Hospital 47. Bhatti Hospital 84. National Institute of Rehabilitation Medicine 48. Sukkur Blood Bank Hospital 85. OGDCL Medical Centre 49. Gambat Pir Abdul Qadir Shah Jilani 86. Rawalpindi Medical College Institute of Medical Sciences Multan 87. Nishtar Medical College & Hospital Punjab 88. Combined Military Hospital Lahore 89. Fatima Medical Center 50. Ghurki Trust Teaching Hospital 51. King Edward Medical University (KEMU) Bahawalpur 52. Combine Military Hospital 90. Bahawal Victoria Hospital 53. Doctors Hospital 91. Cheema Hospital 54. Shalamar Medical College 55. Jinnah Hospital 56. Allama Iqbal Medical College Faisalabad 57. Lahore General Hospital 92. Allied Hospital
40 PNJR Stake Holders Network V SECTION V
PNJR Stake Holders Network
Gujranwala V Principal Investigators 93. Chattha Hospital Surgeons who strive hard to enter the data and keep the 94. District Head Quarter Hospital registry ticking are what keeps this registry alive. 95. Med Care Hospital Following is the list of our registered investigators. Sialkot Sindh 96. Combined Military Hospital Karachi Kharian 1. Prof. Syed Shahid Noor 2. Prof. Muhammad Umar 97. Combined Military Hospital 3. Prof. Zaki Idrees 4. Prof. Muhammad Amin Chinoy Rahim Yar Khan 5. Prof. Mansoor Ali Khan 6. Prof. Anisuddin Bhatti 98. Sheikh Zayed Medical College and Hospital 7. Prof. Maratib Ali 8. Prof. Pervez Anjum 9. Prof. Intikhab Tau q Khyber Pakhtunkhwa 10. Prof. Imtiaz Ahmed Hashmi 11. Prof. Syed Kamran Ahmad Peshawar 12. Prof. Ghulam Mustafa Kaim Khani 13. Prof. Asif Qureshi 99. Hayatabad Medical Complex 14. Prof. A R Jamali 100. Khyber Teaching Hospital 15. Dr. Masood Umer 101. North West General Hospital, Hayatabad 16. Dr. Riaz Hussain Lakdawala 102. Rehman Medical Institute 17. Dr. Pervaiz Hashmi 103. Aman Hospital, Civil Quarters 18. Dr. Sharyar Noordin 19. Dr. Mujahid Jamil 20. Dr. Nasir Ahmad Abbottabad 21. Dr. Aslam Pervez 104. Ayub Medical College 22. Dr. Imran Ali Shah 23. Dr. Sohail Ra 24. Dr. Tashfeen Ahmed 25. Dr. M. Ather Siddiqi Baluchistan 26. Dr. M. Asif Peracha Quetta 27. Dr. Syed Amir Ali Shah 28. Dr. S. Ghazanfar Ali Shah 105. Bolan Medical College 29. Dr. M. Kazim R. Najjad 106. Doctors Hospital 30. Dr. Muhammad Sufyan 107. Akram Hospital 31. Dr. Arshad Qamar 32. Dr. Idrees Shah 33. Dr. Farooq Mamji 34. Dr. Iqbal Malik 35. Dr. Syed Itaat Zaidi 36. Dr. Syed Muhammad Khalid Karim
V PNJR Stake Holders Network 41 SECTION V
PNJR Stake Holders Network
37. Dr. Lt. Col Waris Ali Shah 66. Prof. Sha que Ahmad Shafaq 38. Dr. Lt. Col Syed Faraz Anwar 67. Prof. Rana M. Arshad 39. Dr. Mirza Mohsin Ali Jah 68. Prof. Ali Raza Hashmi 40. Dr. Jagdesh Kumar 69. Prof. Tahseen Riaz 41. Dr. Arshad Jamil 42. Dr. Akram M. Aliuddin 70. Dr. Ahsan Shamim 43. Dr. Syed Danish Ali 71. Dr. Mian Muhammad Hanif 44. Dr. Sabih Nasar 72. Dr. Faisal Qamar 73. Dr. Syed Kashif Mehdi Hyderabad 74. Dr. Sher Afgan 45. Dr. Rais Parvaiz 75. Dr. Rizwan Akram 76. Dr. Muhammad Naveed Larkana 77. Dr. Muhammad Akhtar Malik 78. Dr. Mohammad Fahim Iqbal 46. Prof. Asadullah Mahar 79. Dr. Khurram Sadat 47. Dr. Zamir Soomro 48. Dr. Azizullah Bhayo 80. Dr. Javed Iqbal 49. Dr. Abdul Malik Shaikh 81. Dr. Ijaz Ahmad 82. Dr. Faisal Masood Nawabshah 83. Dr. Atiquz Zaman 50. Prof. Zulfiqar Ali Mastoi 84. Dr. Abdullah Shah 51. Dr. Saeed Samo 85. Dr. Rashid
Sukkur Islamabad / Rawalpindi 52. Prof. Anisuddin Bhatti 86. Prof. Maj. Gen. Sohail Hafeez 53. Dr. Zulfiqar Ali Soomro 87. Prof. Khalid Aslam 54. Dr. Sohail Jokhyo 88. Prof. Riaz Ahmed Shaikh 89. Prof. Nayyar Qayyum Punjab 90. Prof. Muhammad Salim 91. Brig. Dr. Syed Arsalan Haider Bukhari Lahore 92. Dr. Aamir Nabi Nur 55. Prof. Ghazanfar Ali Shah 93. Dr. Farid Ullah Khan Zimri 56. Prof. Amer Aziz 94. Dr. Irfan Masood 57. Prof. S. Muhammad Awais 95. Dr. Syed Shujaat Ali Shah 58. Prof. Abu Bakar Siddiq 96. Dr. Shaheen Iqbal 59. Prof. Rana Dilawaiz Nadeem 97. Dr. Sajjad Orakzai 60. Brig. Prof. Sohail Amin 98. Dr. Rizwan Hameed Malik 61. Prof. Muhammad Abdul Wajid 99. Dr. Ri at Mehmood 62. Prof. Naeem Ahmed 100. Dr. Nouman Maqbool 63. Prof. Shahzad Javed 101. Dr. Moghees Ikram Ameen 64. Prof. Irfan Mehboob 102. Dr. Ali Shami 65. Prof. Yawar Anis 103. Dr. Ali Khokhar 104. Dr. Ali Akhter 42 PNJR Stake Holders Network V SECTION V
PNJR Stake Holders Network
105. Dr. Abidullah Khan Niazi 106. Dr. Obaid-ur-rehman Khyber Pakhtunkhwa 107. Dr. Asim Niaz Naqvi Peshawar 108. Dr. Abdul Basit 127. Prof. Zafar Durrani 109. Dr. Syed Sajid Hussain 128. Prof. Muhammad Arif Khan 110. Dr. Faheem Khan 129. Prof. Zahid Askar 130. Prof. Raja Irfan Qadir Multan 131. Prof. Khushnood Ali Baz 111. Dr. Khalil Ahmed Gill 132. Prof. Malik Javed 112. Dr. Col. Sohail Muzammil 133. Prof. Ayaz Khan 113. Dr. Mohammad Kamran Siddiqi 134. Dr. Zeeshan Khan 114. Dr. Muhammad Jehangir Riaz 135. Dr. Syed Imran Bukhari 136. Dr. Israr Ahmad Bahawalpur 137. Dr. Ghulam Atiq 138. Dr. Awal Hakeem 115. Prof. Tehseen Cheema 139. Dr. Waseem Anwer 116. Prof. Ra q Sabir 117. Dr. Ha z Muhammad Akram Abbottabad Faisalabad 140. Dr. Alamzeb Khan 118. Prof. Ajmal Yasin 119. Dr. Khurram Habib Baluchistan Gujranwala Quetta 120. Dr. Ha z Ahmad Fayyaz 141. Prof. Qazi Masood 121. Dr. Ahmed Masood Ghumman 142. Dr. Saleh Muhammad Tareen 122. Dr. Faisal Iqbal Chaudhry 143. Dr. Muhammad Baksh Shahwani 144. Dr. Attiq Ur Rehman Sialkot 145. Dr. M. Tariq Hasni 123. Dr. Shahid Munir
Kharian 124. Dr. Nisar Ahmed
Rahim Yar Khan 125. Prof. Muhammad Azeem 126. Dr. Abdul Rauf Chaudhry
V PNJR Stake Holders Network 43 SECTION II
PNJR Stake Holders Network
Implant Suppliers
44 PNJR Stake Holders Network V Consolidating Performance and Compliance SECTION VI Amjad Farooq and Basit Farooq
They made world's rst computer virus in 1986. It was made for MS-DOS operating systems. The virus used to infect the boot sector of storage media formatted with the DOS File Allocation Table (FAT) le system. This virus was supposed to stop and track illegal copies of their disk SECTION VI
Consolidating Performance and Compliance
We are proud of our achievements over the past 5 years. We sincerely hope and prey that our concerted e ort PNJR has been the jewel of our eyes and seeing it continues to bear fruit in the future and help develop prosper and grow is very near and dear to the founding the culture of research and innovation in the country members of PAS and PNJR. Nevertheless, It is easy to that we originally planned for. become complacent and we shall lost on what has been achieved in a very short span of time. Therefore, we have started focusing on sustainability. We are taking the following steps in training and development to make this registry self sustainable.
In future, the steering committee has the following vision for the growth of the PNJR.
1. Leadership training. We are training the next generation of arthroplasty surgeons to take up leadership roles in PAS and PNJR steering committee. Change of leadership is inevitable and the earlier the new leaders are identi ed, the sooner they can be groomed to take up leading positions and continue the good work set up by the ofunding members.
2. Data entry and quality management. Automated enrty of implant data using bar code readers is established in high volume centers. Automatically generated performace reports on quarterly basis are issued to users and the steering committee on as need basis for monitoring and quality assurance. We have a quality control and monitoring cell. With the ever increasing number of users, and upgradation of the registry. A monitoring unit is essential to ensure that the data being entered is of su cient quality to merit analysis. Without this we believe that the registry will cease to have scienti c value over time
3. Elevating the status of PNR to a compulsory national register. Currently we are a voluntary register. The next step is to get a government approval for conversion of this registry to a national government run and funded compulsory register. This will elevate not the only status but the credibility of the data and we would then truly reperesnt all joint surgeons in Pakistan. As mentioned before, we envision to establish a governing body. This will enable us in making not only PNJR but also other healthcare registries compulsory so that we can produce credible national data on disease prevalence, treatment modalities and patient outcomes.
VI Consolidating Performance and Compliance 47 Data Analysis and Reporting PART 2 PNJR 5th Annual Report Primary Total Knee Arthroplasty SECTION I
SECTION I
Primary Total Knee Arthroplasty
Gender Distribution
2nd Year 3rd Year 4th Year 5th Year
68% 66% 68% 60%
40% 34% 32% 32%
Male Female
Age Category
2nd Year 3rd Year 4th Year 5th Year 1897 1838
1351
1017
795
256 139 155 19 26 32 65
< 50 51-80 >80
I Primary Total Knee Arthroplasty 51
SECTION I
Primary Total Knee Arthroplasty
Geographical Distribution
2nd Year 3rd Year 4th Year 5th Year
1166 1247 1019 1033 932
724
453 402 374
30 47 19 14 22 44
Sindh Punjab KPK Balouchistan
Diagnosis
2431 2nd Year 3rd Year 4th Year 5th Year
1879
1271
1005
166 144 94 52 76 78 20 29 2 15 1 0 1 4 7 0 6 8 8 10 13 37 23 15
Other Primary Tumor Secondary Arthritis Rheumatoid In ammatory Osteonecrosis Osteoarthritis Osteoarthritis
I Primary Total Knee Arthroplasty 53
SECTION I
Primary Total Knee Arthroplasty
Pre-operative deformity 2nd Year 3rd Year 4th Year 5th Year
1481 1102 968 906 922
581 513 484
176 210 87 74 39 39 81 39
Varus Fixed Flexion Valgus Recurvatum Deformity
ASA Grading
2nd Year 3rd Year 4th Year 5th Year 1825 1746
951 765
441 268 332 205 199 168 115 137 118 102 25 40 1 38 56 62
Grade 1 Grade 2 Grade 3 Grade 4 Not Documented
I Primary Total Knee Arthroplasty 55
SECTION I
Primary Total Knee Arthroplasty
Anaesthesia
2nd Year 3rd Year 4th Year 5th Year
1683 1340 1306
847
544 372 285 215 152 174 176 194
General Spinal + Epidural Spinal
Implant Types according to level of constraint
PS 2229 CR 392 CCK 70 RHK 7
I Primary Total Knee Arthroplasty 57 SECTION I
Primary Total Knee Arthroplasty
Implant Types according to Fixation of Tibial Insert
2596 Fixed Bearing Tray 102 Mobile Bearing Tray
Implant Types according to built in exion
2475 Standard Flexion 223 High Flexion
58 Primary Total Knee Arthroplasty I SECTION I
Primary Total Knee Arthroplasty
Cementing Techniques 2nd Year 3rd Year 4th Year 5th Year
1829 1911 1777 1692 1479
913 819 621
467
144 123 135
Cement on Implant Pulse Lavage Vaccum Mixing
Thromboprophylaxis
2nd Year 3rd Year 4th Year 5th Year 1784
1027 1062
875 753 712 606 625
Chemical Mechanical
I Primary Total Knee Arthroplasty 59 SECTION I
Primary Total Knee Arthroplasty Post operative Analgesia 2nd Year 3rd Year 4th Year 5th Year 2166 1790 1690
1373
1036 962 865 898 748 636
429 271 132 116 60 70 87 55 28 47 8 16 43 25
Epidural Oral Intra Venous Intra Intra Patient Muscular Operative Controlled Local Analgesia
Adverse intraoperative events
2nd Year 3rd Year 4th Year 5th Year
16 16 14 12 11 10 7 7 6 5 4 3 2 2 2 0
Fracture Patellar Tendon Ligament Injury Others Avulsion
60 Primary Total Knee Arthroplasty I SECTION I
Primary Total Knee Arthroplasty Implant Details 2nd Year 3rd Year 4th Year 5th Year
1097
878 897
755
651
577
511 465
293 263 240 239
179 153 134 116 107 78 82 61 76 47 45 42 25 20 31 2 8 0 16 3 4 0 1 0 2 0 0 2 2 0 0 0 2 0 0 15
A-3 Others ZIMMER BIOMET UNITED WRIGHT SURGIVAL DEPUY J AND J IMPLANT CAST CUSTOM MADE SMITH & NEPHEW WALDEMAR LINK
I Primary Total Knee Arthroplasty 61
Revision Total Knee Arthroplasty SECTION II
SECTION II
Revision Total Knee Arthroplasty
Gender Distribution
2nd Year 3rd Year 4th Year 5th Year
71% 66% 61% 58%
42% 39% 39% 29%
Male Female
Age Category
2nd Year 3rd Year 4th Year 5th Year
87
51
36 33
20 13 17 9 4 6 7 1
< 50 51-80 >80
II Revision Total Knee Arthroplasty 65
SECTION II
Revision Total Knee Arthroplasty
Diagnosis
2nd Year 3rd Year 4th Year 5th Year
35
27 25
17 15 14 14 12 12 8 8 8 6 6 7 4
Aseptic Loosening Instability Prosthetic Joint Periprostheic Infection Fracture
Implant Detail
2nd Year 3rd Year 4th Year 5th Year
40 36
27
18 18 19 14 15 15 12 11 11 8 7 5 4
CCK RHK / S-ROM MBT+metaphyseal Metal Sleeve Augments
II Revision Total Knee Arthroplasty 67
Primary Total Hip Arthroplasty SECTION III
SECTION III
Primary Total Hip Arthroplasty
Gender Distribution 2nd Year 3rd Year 4th Year 5th Year
65% 64% 62% 63%
38% 36% 36% 35%
Male Female
Age Category 2nd Year 3rd Year 4th Year 5th Year
462 437
380 380
316
232 177 151
32 7 24 18
< 50 51-80 >80
III Primary Total Hip Arthroplasty 71
SECTION III
Primary Total Hip Arthroplasty
Geographical Distribution 2nd Year 3rd Year 4th Year 5th Year
431 389
307
250 243 230 236 191
127
56 46 34 24 12 7 11
Sindh Punjab KPK Balouchistan
Pre Operative Ambulatory Status 2nd Year 3rd Year 4th Year 5th Year
359 366 348
264 266 269
152 154 99
57 51 54 53 56 32 31
Community Home Ambulator Non Ambulator Not Documented Ambulator
III Primary Total Hip Arthroplasty 73
SECTION III
Primary Total Hip Arthroplasty
Diagnosis 2nd Year 3rd Year 4th Year 5th Year 385 308
264 222
187 187 169 143
98 76 87 87 41 25 32 28 29 19 18 6
Osteonecrosis Primary Secondary Rheumatoid In ammatory Osteoarthritis Osteoarthritis Arthritis Arthritis
ASA Grading 2nd Year 3rd Year 4th Year 5th Year 373 358 312 274
211 216 199
106 93 89 83 73 54 52 42 37 5 8 2 7
Grade 1 Grade 2 Grade 3 Grade 4 Not Documented
III Primary Total Hip Arthroplasty 75 SECTION III
Primary Total Hip Arthroplasty
Types of Anesthesia 2nd Year 3rd Year 4th Year 5th Year
422 423
329 315
264 240 229 204 209 166
102 68 62 47 32 0
General Spinal Epidural Not Documented
Surgical Incisions 2nd Year 3rd Year 4th Year 5th Year 714 668 541
343
75 62 56 40 38 11 13 32
Standard MIS Not Documented
76 Primary Total Hip Arthroplasty III SECTION III
Primary Total Hip Arthroplasty
Surgical Approaches 2nd Year 3rd Year 4th Year 5th Year
576
469 469
332
137 93 73 63 56 49 27 32 18 41 34 16 0 0 2 14
Lateral Posterior Anterolateral Anterior Not (Hardinge) (Southen) (Watson Jones) (Smith Peterson) Documented
Drain Used 2nd Year 3rd Year 4th Year 5th Year 664 533
464
266 242
110 79 91 71 53 13 8
Yes No Not Documented
III Primary Total Hip Arthroplasty 77 SECTION III
Primary Total Hip Arthroplasty
Thromboprophylaxis 2nd Year 3rd Year 4th Year 5th Year 452 472
333 379 301
228 219
169
28 24 3 18
Chemical Mechanical Not Documented
Adverse Intraoprative Events 2nd Year 3rd Year 4th Year 5th Year 18
15
13 10 10 9 8 8
6 6
4 3 2 1 1 0
Fracture Vascular Injury Nerve Injury Other
78 Primary Total Hip Arthroplasty III SECTION III
Primary Total Hip Arthroplasty Post operative Analgesia 2nd Year 3rd Year 4th Year 5th Year
489
382 389
292 270 250 236 191
50 78 42 30 38 28 42 18 9 17 22 16 9 8 12 16
Epidural Intra Venous Oral Intra Patient Intra Operative Controlled Muscular Local Analgesia
Implant Details 2nd Year 3rd Year 4th Year 5th Year
380 327 292 244 223 201 170 173
121
80 71 76 65 59
35 30 24 19 10 8 3 1
Cemented Uncemented Hybrid Resurfacing Dual Not Mobility Documented
III Primary Total Hip Arthroplasty 79 SECTION III
Primary Total Hip Arthroplasty
Bearing Surfaces
394 2nd Year 3rd Year 4th Year 5th Year 342
277 255
194 179 174 163
84 56 54 33 34 22 28 6 11 14 12 10 16 3 2 1 Metal on Metal on Ceramic on Ceramic on Ceramic on Metal on standard Crosslinked Crosslinked Poly Ceramic Metal Poly Poly Poly
Cementing Technique 2nd Year 3rd Year 4th Year 5th Year 553
386 372
231 228 237
190 187 179 169 148 126 131 119 88 89 73 77 78 56 57 56 45 40 25 28 16 0
Cement Cement Proximal Pulse Stem Vaccum Not Gun Restrictor Pressurizer Lavage Centralizer Mixing Documented
80 Primary Total Hip Arthroplasty III SECTION III
Primary Total Hip Arthroplasty
Post Op Weight Bearing
2nd Year 3rd Year 4th Year 5th Year 399 357 352 315 317 256
196 168
66 71 52 45
Full Weight Bearing Non Weight Bearing Not Documented
Age Category
2nd Year 3rd Year 4th Year 5th Year 332 278 232
184
137 123 122 116 106 102 93 91 78 73 65 67 58 62 63 58 47 30 25 27 22 7 7 10 0 0 2 2 1
SERF DEPUY TIPMED UNITED ZIMMER BIOMET SURGIVAL EVOLUTIS BIOLEX DELTA IMPLANT CAST SMITH & NEPHEW
III Primary Total Hip Arthroplasty 81
Revision Total Hip Arthroplasty SECTION IV
SECTION IV
Revision Total Hip Arthroplasty
Age Category
2nd Year 3rd Year 4th Year 5th Year 121
79 77 59
22 20 15 17 12 2 1 3
< 50 51-80 >80
Gender Distribution
2nd Year 3rd Year 4th Year 5th Year 68% 60% 57% 49% 43% 40% 40%
28%
Male Female
IV Primary Total Hip Arthroplasty 85
SECTION IV
Revision Total Hip Arthroplasty
Implant Detail 2nd Year 3rd Year 4th Year 5th Year
74
52
40 33 34 29 32
22 23 15 12 11 14 11 10
0
All Cemented Dual Mobility Uncemented Hybrid
Diagnosis 2nd Year 3rd Year 4th Year 5th Year
35 35 28 24 19 21 17 16 18 17 14 12 12 13 8 9 8 7 8 6 5 5 5 5 4 2 2 0
Aseptic Infection Dislocation Fracture Instability Implant Aseptic Loosening Breakage Loosening Acetabular Femur
IV Primary Total Hip Arthroplasty 87 PAS Current National Board
Prof. Syed Shahid Noor Prof. G.A. Shah President Patron Liaquat National Hospital, Karachi. Doctor Hospital, Lahore.
Prof. Maj. General Sohail Hafeez Prof. Muhammad Amin Chinoy General Secretary Treasurer Shifa International Hospital, Islamabad. Indus Hospital, Karachi.
Prof. Mansoor Ali Khan Prof. Amir Aziz Vice President South Vice President North Indus Hospital, Karachi. Gurki Trust Hospital, Lahore.
Prof. Birg. Sohail Amin Dr. Muhammad Ather Siddiqi Joint Secretary North Joint Secretary South CMH, Lahore. Liaquat National Hospital, Karachi.
Prof. Muhammad Arif Khan Dr. M. Kazim R. Najjad Executive Member Executive Member Hayatabad Medical Complex, Peshawar. LNH, Karachi.
Dr. Nasir Ahmed Dr. Imran Shabbir Mughal Executive Member Executive Member Patel Hospital, Karachi. Lahore General Hospital, Lahore.
88 PAS Current National Board PAS International Fellows
Dr. Muhammad Ather Siddiqi Dr. Syed Amir Ali Shah Singapore General Hospital, Singapore General Hospital, Singapore. Singapore.
Dr. Tariq Hasni Dr. Imran Bukhari Chang Gung Memorial Hospital, Singapore General Hospital, Linkou, Taiwan. Singapore.
Dr. Waqas Ali Dr. Muhammad Yasir Pervez University Hospital of Leicester Australian Orthopaedic Association NHS Trust, UK Fellowship, Sydney, Australia
Dr. Irfan Muhammad Rajput Dr. Muhammad Jahangir Riaz University Hospital of Leicester National University of Singapore NHS Trust, UK
PAS International Fellows 89 PAS National Fellows
Dr. Syed Imran Bukhari Dr. Obaid-ur-Rehman LNH & MC, Karachi CMH, Rawalpindi
Dr. Roohullah Jan Dr. M. Kazim R. Najjad CMH, Rawalpindi LNH & MC, Karachi
Dr. Ghulam Abbas Jafri Dr. Muhammad Jahangir Riaz GTTH, Lahore IOS, Karachi
Dr. Muhammad Yasir Pervez Dr. Imran Shabir Mughal CMH, Rawalpindi LNH & MC, Karachi
Dr. Noman Shakeel Niazi Dr. Irfan Muhammad Rajput GTTH, Lahore IOS, Karachi
90 PAS National Fellows PAS National Fellows
Dr. Waqas Ali Dr. Ghazanfar Ali Shah IOS, Karachi LNH & MC, Karachi
Dr. Syed Kashif Mehdi Dr. Sher Afgan CMH, Rawalpindi GTTH, Lahore
Dr. Hafiz Ahmed Fayyaz Bajwa Dr. Kashif Siddiq LNH & MC, Karachi IOS, Karachi
Dr. Syed Ali Anwar Jilani Dr. M. Irshad Khan CMH, Rawalpindi QIH, Islamabad
Dr. Hafiz Azhar Hussain Dr. Ali Amjed Shifa CMH, Rawalpindi International Hospital, Islamabad
PAS National Fellows 91 PAS National Fellows
Dr. M. Imran Haider Dr. Aziz ur Rehman LNH & ISO, Karachi CMH, Rawalpindi
Dr. Akram M. Aliuddin Dr. Mehroze Zamir LNH & ISO, Karachi LNH, Karachi
Dr Vickash Kumar ISO & South City Hospital, Karachi
92 PAS National Fellows
Pakistan Arthroplasty Society (regd.)
Department of Orthopaedic, Building-K, 1st Floor, Liaquat National Hospital & Medical College, Stadium Road, Karachi 74800, Pakistan.
Tel: +92-21-34412640 UAN: 111-456-456
Emails: [email protected] Web: www.arthroplasty.org.pk